Ju-Yi Chen

Uric acid is an independent predictor of arterial stiffness in hypertensive patients

Increased arterial stiffness is an important marker for target organ damage in essential hypertension. Both serum uric acid (UA) and C-reactive protein (CRP) were reported to be associated with target organ damage. However, the influences of UA and CRP on large arterial stiffness were not well elucidated. This study included 200 essential hypertension patients (64 women) whose age was between 20 and 50 years old (mean age 41 ± 8 years). None of the patients had diabetes mellitus or overt end-organ damage. Arterial stiffness was assessed by pulse-wave velocity (PWV) measured by tonometry from carotid to radial artery. Serum UA, high-sensitivity CRP (hsCRP), glucose, insulin, and lipid profiles were measured at the same time in each patient. PWV levels were significantly correlated with mean blood pressure (r = 0.245, P < 0.001), diastolic blood pressure (r = 0.323, P < 0.001), high-density lipoprotein (r = −0.169, P = 0.016), and UA (r = 0.234, P = 0.001), but not age, body mass index, blood sugar, insulin, low-density lipoprotein, triglyceride, and hsCRP. Pulsewave velocity levels were significantly higher in males (8.9 ± 1.2 vs 8.2 ± 1.2 m/s, P < 0.001) and smokers (9.3 ± 1.1 vs 8.5 ± 1.2 m/s, P < 0.001). Uric acid was significantly correlated with hsCRP (r = 0.294, P < 0.001). After multivariate analysis controlling for all possible confounding factors, UA (odds ratio 1.28, 95% confidence interval 1.02–1.61, P = 0.032) was still independently associated with increased PWV. In conclusion, UA but not hsCRP was independently associated with increased PWV in essential hypertension. Although UA was correlated with hsCRP, the association between UA and PWV was not through the effect of enhanced inflammation.

Stiffness index derived from digital volume pulse as a marker of target organ damage in untreated hypertension

Objective. An index of large artery stiffness (SIDVP) simply derived from the digital volume pulse (DVP) was developed recently. However, the role of the SIDVP in untreated hypertensive patients was not well elucidated. Methods. We enrolled 124 untreated hypertensive patients (mean age 55.4±13.1 years, 57 men). The DVP was measured in right index finger by a photoplethysmography. The SIDVP was formulated as body height divided by transition time from early systolic peak to the inflection point of reflection wave. Two functional indices of aortic compliance, stiffness index (SI) and distensibility (DI), were also used for measurement of aortic stiffness. Results. The SIDVP was significantly correlated with blood urea nitrogen (BUN), and left ventricular mass index (LVMI). Patients with vascular diseases had higher level of SIDVP (10.12±2.97 vs 8.45±1.78, p<0.001), SI (13.76±7.63 vs 10.87±8.88, p = 0.116), BUN (28.4±24.7 vs 14.5±4.6, p<0.001) and lower level of DI (1.34±0.88 vs 1.93±1.12, p = 0.010) than those without vascular diseases. By multivariate analysis, only the SIDVP was significantly associated with vascular diseases (OR 1.39, 95% CI 1.06–1.82, p = 0.016). Conclusions. SIDVP, SI and DI were significantly correlated with target organ damage in untreated hypertension. However, only the SIDVP was independently associated with presence of vascular diseases. SIDVP simply derived from the DVP can be used as a marker for risk stratification in untreated hypertensive patients.

Novel Compliance Index derived from digital volume pulse associated with risk factors and exercise capacity in patients undergoing treadmill exercise tests

Objective Although large-artery stiffness is a well-known independent factor for cardiovascular risk, the importance of small-artery stiffness is not well elucidated. We have developed a novel Compliance Index as a marker of small-artery stiffness. This study aimed to determine the clinical significance of this index by evaluating 140 patients without left ventricular dysfunction referred for treadmill exercise tests. Methods Immediately after a 10-min rest period before the test, the pulse wave velocity and Compliance Index were measured. The patients were then given a symptom-limited treadmill test using Bruces protocol. Our dual-channel photoplethysmography system automatically measured the area under the curve of each digital volume pulse, which represented the volume change in the finger with each heart beat. The Compliance Index was calculated by dividing the area under the curve of finger digital volume pulse by pulse pressure. Results The Compliance Index was significantly correlated with pulse wave velocity (r = −0.254, P = 0.002), systolic blood pressure (r = −0.606, P < 0.001), and diastolic blood pressure (r = −0.323, P < 0.001). It was lower in males (3.3 ± 1.4 versus 4.8 ± 2.4 units, P < 0.001), in hypertensive patients (3.2 ± 1.5 versus 4.4 ± 2.2 units, P < 0.001), and in smokers (3.0 ± 1.5 versus 4.1 ± 2.1 units, P = 0.006). Conclusions The Compliance Index was lower in patients with risk factors and was associated with poor exercise capacity. This index may be clinically useful for evaluating arterial stiffness.

Treatment with dextromethorphan improves endothelial function, inflammation and oxidative stress in male heavy smokers

Summary.  Background: Dextromethorphan (DM) is reported to reduce the inflammation‐mediated degeneration of dopaminergic neurons. Objective: The goal of this study was to test if DM can improve the endothelial dysfunction and inflammatory markers in heavy smokers. Patients and methods: Forty habitual smoking healthy male volunteers (mean age, 31.5 ± 1.4 years) were randomly given either DM (120 mg day−1) or a placebo for 6 months. We determined endothelial function using the brachial artery diameter changes in flow‐mediated dilatation (FMD) and measured their inflammatory and oxidative markers. A sex‐and‐age matched non‐smoking group (n = 20) was compared as normal parameters. Results: Habitual smokers showed impaired baseline endothelial function in FMD (smoking vs. non‐smoking: 6.3 ± 1.8 vs. 10.2 ± 2.3% respectively, P < 0.01). Without change in smoking behavior, lipid and metabolic parameters, a significant increase in FMD was found in the DM‐treated group (32%), accompanied by a decrease in high‐sensitivity C‐reactive protein (hs‐CRP), phospholipase A2, matrix metalloproteinase‐3, interleukin 6 (IL‐6) and tumor necrosis factor‐α receptor II (TNF‐α RII) (all P < 0.05), but unchanged in von Willebrand factor (VWF)and plasminogen activator inhibitor‐1 (PAI‐1). An increase in plasma glutathione peroxidase and a decrease in spot urinary excretion of 8‐epi‐prostaglandin F2a were found in DM‐treated smokers. Conclusions: Our study suggests that a 6‐month treatment with DM can improve endothelial function and attenuate vascular oxidative stress and inflammation markers in habitual smokers.

Association of central aortic pressures indexes with development of diabetes mellitus in essential hypertension.

BACKGROUND Diabetes mellitus (DM) and hypertension (HT) frequently coexist. Increased central aortic pressures indexes are associated with HT; however, possible associations of these indexes with future development of DM have never been studied in HT. METHODS We recruited 178 patients with uncomplicated nondiabetic HT in this study. Baseline glucose, insulin, lipid profiles, and central aortic pressure indexes obtained using applanation tonometry were measured at the beginning of the study. Patients were followed for new-onset DM. RESULTS After a mean follow-up period of 31 ± 12 months, 22 patients (12.4%) developed new-onset DM. In multivariate regression analyses adjusted for age, sex, and mean blood pressure (BP) in model 1, we found that central systolic BP (CSBP; hazard ratio 1.24, 95% CI 1.10-1.41, P < 0.001), and augmentation index (AIx) corrected at heart rate 75/min (AIx(75); hazard ratio 1.58, 95% CI 1.11-1.58, P < 0.05) were independent predictors for new-onset DM. After adjustment for age, sex, mean BP, glucose concentration, and β-blocker use in model 2, we found that CSBP (hazard ratio 1.36, 95% CI 1.19-1.55, P < 0.001) and AIx(75) (hazard ratio 1.71, 95% CI 1.16-2.52, P < 0.01) were independent predictors for new-onset DM. CONCLUSIONS CSBP and AIx(75) were independent factors for future DM in essential hypertensive patients. Increased central pressure indexes were associated with risk of DM in essential hypertension.

Association of adiponectin with procollagen type I carboxyterminal propeptide in non-diabetic essential hypertension

Objective. The serum concentration of procollagen type I carboxyterminal propeptide (PICP) is a good marker for collagen deposition in hypertension. Increased collagen deposition was associated with myocardial fibrosis and increased arterial stiffness. A decreased adiponectin level is associated with increased atherosclerosis. The role of adiponectin and its relation to PICP in essential hypertension have rarely been studied before. Methods. We recruited 188 non‐diabetic uncomplicated hypertensive patients (mean age: 41±7 years; 128 men). No patient had vascular complications or renal or liver diseases. Overnight fasting blood samples were collected to assess patient lipid profiles, blood sugar, insulin, high‐sensitivity C‐reactive protein (hsCRP), PICP and adiponectin. Carotid to radial pulse wave velocity (PWV) measured using tonometry was used as an index of arterial stiffness. Results. Adiponectin (r = −0.216, p = 0.003) and male gender (p<0.001) were independent determinants of PICP. Diastolic blood pressure (r = 0.422, p<0.001) and current smoking (p = 0.005) were independent determinants of PWV. PWV was significantly correlated with PICP (r = 0.156, p = 0.034). Adiponectin was significantly correlated with triglyceride (r = −0.276, p<0.001), high‐density lipoprotein (r = 0.262, p<0.001), the homeostasis model assessment (HOMA) index (r = −0.220, p = 0.002), hsCRP (r = −0.207, p = 0.004) and the body mass index (BMI) (r = −0.202, p = 0.005). After compensation with possible confounding factors, adiponectin was still significantly correlated with PICP (beta = −0.196, p = 0.006). Conclusion. Serum adiponectin may be a marker for metabolic syndrome in essential hypertension. Adiponectin was significantly negatively correlated with PICP. Metabolic syndrome probably plays an important role in increased collagen synthesis and arterial stiffness through the effects of decreased adiponectin in non‐diabetic essential hypertension.

Association of increased arterial stiffness and inflammation with proteinuria and left ventricular hypertrophy in non‐diabetic hypertensive patients

Objective. Both arterial stiffness and proteinuria are important markers for organ damage in hypertension. This study was planed to investigate the association between arterial stiffness and inflammation and to define the influences of proteinuria on arterial stiffness and inflammation in non‐diabetic hypertension. Methods. We enrolled 205 patients (mean age 41±8 years, 66 women) with essential hypertension noted for less than 5 years in this study. They did not have diabetes mellitus or any overt cardiac, vascular, or renal complications. Stiffness index (SI) derived from digital volume pulse was used for assessment of arterial stiffness. High‐sensitivity C‐reactive protein (hsCRP) was measured in each patient during enrollment. Left ventricular hypertrophy (LVH) was documented by electrocardiography and proteinuria was assessed by measuring 24‐h urine protein. Results. SI was significantly correlated with hsCRP (r = 0.166, p = 0.017). LVH was noted in 34 patients (17%). SI was significantly higher in patients with LVH (8.03±1.74 vs 7.19±1.19 m/s, p = 0.001). Proteinuria was noted in three patients with LVH. SI was gradually increased among patients without LVH, with LVH but not proteinuria, and with LVH and proteinuria (7.19±1.19, 7.68±1.21, 11.75±2.51 m/s respectively; p<0.001). HsCRP was also gradually increased among patients without LVH, with LVH but not proteinuria, and with LVH and proteinuria (0.20±0.24, 0.30±0.59, 1.56±1.58 mg/dl respectively; p<0.001). Conclusions. SI was significantly correlated with hsCRP. Arterial stiffness and inflammation were increased in association with proteinuria in non‐diabetic essential hypertension.

Safety of transvenous temporary cardiac pacing in patients with accidental digoxin overdose and symptomatic bradycardia

Background: Patients with digoxin intoxication may need transvenous temporary cardiac pacing (TCP) when symptomatic bradyarrhythmias are present. However, it has been reported that TCP might be associated with fatal arrhythmias in patients with acute digitalis intoxication caused by attempted suicide. The aim of this study was to assess the safety of TCP in patients with accidental digoxin-related symptomatic bradyarrhythmias. Materials and Methods: Seventy patients (30 men; age 74 ± 12 years) were enrolled in this retrospective study. Patients were divided into two groups: group 1 with TCP and group 2 without TCP. A digoxin overdose was defined as a serum digoxin level higher than 2.0 ng/ml combined with the presence of digoxin-related symptoms. Detailed clinical characteristics were reviewed on the basis of the medical records. Results: Group 1 included 24 patients (34.3%, 10 men). The rhythms prior to pacemaker insertion in group 1 included sinus arrest with junctional bradyarrhythmias (n = 9), atrial fibrillation with a slow ventricular rate (n = 11), and high-degree atrioventricular block (n = 4). The mean duration of pacemaker implantation was 5.8 ± 2.9 days (2–12 days). There was no major arrhythmic event or mortality after TCP in group 1. Two patients in group 2 (4%) died of ventricular tachyarrhythmias. Group 1 had a higher level of blood urea nitrogen (45.1 ± 26.0 vs. 33.4 ± 19.3 mg/dl), of left ventricular ejection fraction (68 vs. 56%), and of digoxin (4.4 ± 2.1 vs. 3.4 ± 1.3 ng/ml) but a lower serum calcium level (8.7 ± 0.6 vs. 9.1 ± 0.8 mg/dl). Conclusion: TCP was safe for patients with a digoxin overdose complicated by symptomatic bradycardia and should be recommended in such situations. However, this conclusion does not apply to acute digoxin intoxication as a result of attempted suicide.

Effects of rosiglitazone on the cardiovascular profile in postmenopausal women without diabetes mellitus: interplay of thiazolidinediones and hormone therapy.

Objective Thiazolidinediones have antiatherothrombotic effects on persons with diabetes. Hormone therapy among postmenopausal women has both positive and negative cardiovascular effects. However, the effects of rosiglitazone with or without concurrent long-term hormone therapy on the cardiovascular profile of nondiabetic postmenopausal women are unknown. Methods Thirty-eight nondiabetic postmenopausal women were enrolled in this double-blind and placebo-controlled study. Eighteen participants received 4 mg rosiglitazone, and 20 participants took placebo daily for 12 weeks. Global endothelial function and plasma biomarkers were measured. Results Baseline characteristics and parameters were similar between the groups. Rosiglitazone, but not placebo, significantly reduced leukocyte count and plasma levels of matrix metalloproteinase-9 and inhibited the elevation of plasma levels of plasminogen activator inhibitor-1 and tissue plasminogen activator (P < 0.05 for all). Most of the favorable effects provided by rosiglitazone were still present in participants with concurrent hormone therapy. Increased body weight and waist size as well as elevation of the plasma levels of total and low-density lipoprotein cholesterol were noted after rosiglitazone treatment among participants without concurrent hormone therapy. No significant change in the global endothelial function occurred in response to treatment in either group. Conclusions Rosiglitazone treatment provided both protective and harmful cardiovascular effects in nondiabetic postmenopausal women. Concurrent hormone therapy resulted in the maintenance of the major beneficial effects while neutralizing the unfavorable effects of rosiglitazone.

Unusual pneumopericardium during permanent pacemaker implantation

An 80-year-old man underwent permanent dual-chamber pacemaker implantation for his sick sinus syndrome. During the implantation procedure, the patient complained of mild shortness of breath after left subclavian vein puncture. Under fluoroscope, mild left pneumothorax was found. There was an airspace subsequently interposing between the main pulmonary artery and left atrial appendage with mild protrusion …